The working alliance in stuttering treatment: a neglected variable?

Background Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The ‘working alliance’ is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular. Aims To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients’ concept of motivation and treatment outcomes 6 months post‐therapy. Methods & Procedures Eighteen adults (21‐61 years) participated in this multiple single‐case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory—Short Version Revised (WAI‐SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST‐E), the Overall Assessment of Speakers’ Experience of Stuttering—Adult version (OASES‐A), the Wright & Ayre Stuttering Self‐Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS). Outcomes & Results Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post‐treatment. The association between client‐led goals and therapy tasks appeared particularly important. Conclusions & Implications The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client–clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted

Qualitative study of system-level factors related to genomic implementation

PURPOSE: Research on genomic medicine integration has focused on applications at the individual level, with less attention paid to implementation within clinical settings. Therefore, we conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify system-level factors that played a role in implementation of genomic medicine within Implementing GeNomics In PracTicE (IGNITE) Network projects. METHODS: Up to four study personnel, including principal investigators and study coordinators from each of six IGNITE projects, were interviewed using a semistructured interview guide that asked interviewees to describe study site(s), progress at each site, and factors facilitating or impeding project implementation. Interviews were coded following CFIR inner-setting constructs. RESULTS: Key barriers included (1) limitations in integrating genomic data and clinical decision support tools into electronic health records, (2) physician reluctance toward genomic research participation and clinical implementation due to a limited evidence base, (3) inadequate reimbursement for genomic medicine, (4) communication among and between investigators and clinicians, and (5) lack of clinical and leadership engagement. CONCLUSION: Implementation of genomic medicine is hindered by several system-level barriers to both research and practice. Addressing these barriers may serve as important facilitators for studying and implementing genomics in practice

Studies of run-away electron beams and hard x-ray emission in ISTTOK tokamak

The paper describes measurements of fast run-away electron beams emitted from a plasma torus in the ISTTOK tokamak, which were performed by means of a new Cherenkov-type detector equipped with four radiators made of aluminium-nitrate (AlN) crystals of 10 mm in diameter and 2.5 mm in thickness each. The measuring head was fixed to a movable support, which enabled the radiators to be placed in chosen positions along the minor radius of ISTTOK. The radiators were coated with molybdenum (Mo) layers of different thicknesses since the main aim of this study was to estimate an energy spectrum of the recorded electrons. Attention was also paid to measurements of hard X-rays emitted from ISTTOK and to their correlations with run-away electrons. The investigated correlations showed that the both emissions are strongly coupled.Описано виміри швидких втікаючих електронних пучків, що випускається з плазмового тора в токамаці ISTTOK, що було виконано за допомогою нових черенковських детекторів, оснащених чотирма радіаторами з нітратуалюмінію (AIN) із кристалами діаметром 10 і товщиною 2,5мм кожний. Вимірювальна головка була встановлена на рухливій підставі,що дозволило розміщати радіатори в обраних позиціях по малому радіусі ISTTOK. Радіатори були покриті молібденовими (Мо) шарами різної товщини ,оскільки основною метою даного дослідження було оцінити енергетичний спектр електронів, що регіструються. Увага була також приділена виміру твердого рентгенівського випромінювання з ISTTOK і його кореляції з втікаючими електронами. Досліджені кореляції показали, що обоє випромінювання сильно зв’язані.Описываются измерения быстрых убегающих электронных пучков, испускаемых из плазменного тора в токамаке ISTTOK, которые были выполнены с помощью новых черенковских детекторов, оснащенных четырьмя радиаторами из нитратаалюминия (AIN) с кристаллами диаметром 10 и толщиной 2,5 мм каждый. Измерительная головка была установлена на подвижном основании, что позволило размещать радиаторы в выбранных позициях по малому радиусу ISTTOK. Радиаторы были покрыты молибденовыми (Мо) слоями различной толщины, поскольку основной целью данного исследования было оценить энергетический спектр регистрируемых электронов. Внимание было также уделено измерению жесткого рентгеновского излучения из ISTTOK и его корреляции с убегающими электронами. Исследованные корреляции показали, что оба излучения сильно связаны

Cardiac injury of the newborn mammalian heart accelerates cardiomyocyte terminal differentiation

After birth cardiomyocytes undergo terminal differentiation, characterized by binucleation and centrosome disassembly, rendering the heart unable to regenerate. Yet, it has been suggested that newborn mammals regenerate their hearts after apical resection by cardiomyocyte proliferation. Thus, we tested the hypothesis that apical resection either inhibits, delays, or reverses cardiomyocyte centrosome disassembly and binucleation. Our data show that apical resection rather transiently accelerates centrosome disassembly as well as the rate of binucleation. Consistent with the nearly 2-fold increased rate of binucleation there was a nearly 2-fold increase in the number of cardiomyocytes in mitosis indicating that the majority of injury-induced cardiomyocyte cell cycle activity results in binucleation, not proliferation. Concurrently, cardiomyocytes undergoing cytokinesis from embryonic hearts exhibited midbody formation consistent with successful abscission, whereas those from 3 day-old cardiomyocytes after apical resection exhibited midbody formation consistent with abscission failure. Lastly, injured hearts failed to fully regenerate as evidenced by persistent scarring and reduced wall motion. Collectively, these data suggest that should a regenerative program exist in the newborn mammalian heart, it is quickly curtailed by developmental mechanisms that render cardiomyocytes post-mitotic

Resilience beyond neoliberalism? Mystique of complexity, financial crises, and the reproduction of neoliberal life

The burgeoning debate on resilience in international relations has seen the emergence of two polarized views: resilience as a manifestation of neoliberal governmentality and resilience as the expression of a post-neoliberal shift. This article explores whether a post-neoliberal resilience may be possible by reflecting upon the ontology of complexity as unknowability at the heart of this view. It argues that this approach neglects how the discourse of complexity as unknowability is a neoliberal technology of government that is instrumental to advance neoliberal forms of resilience. The second half of the article discusses this argument with reference to the 2008 financial crisis. It shows how a resilience-as-post-neoliberal approach resonates with those dominant narratives which have shrouded the causes and mechanics of the crisis in a mystique of complexity, thus encouraging forms of cognitive and political disengagement. The article concludes that by celebrating local knowledge at the expense of an understanding of global dynamics, post-neoliberal resilience offers an impoverished notion of resistance compliant with the dictates of the neoliberal order

Artificial Intelligence and Machine Learning for Systems Analysis of the 21st Century

This paper overviews research being done at IIASA with use of machine learning (ML) methods. We elaborate on promising areas of application and advantages and challenges of using ML. These reflections are done as a part of strategic planning process going on at IIASA at the moment, which aims to come up with a new research strategy for 2021-2030, as well as a supporting research plan. It has been recognized that while applications of ML in commercial sector are numerous and become more and more powerful day to day, it is not yet so common to use ML for creating societal impact. To explore the opportunities in this context and to reflect on what IIASA’s role might be, an internal working group was initiated. This paper emerged from the internal workshop held by the working group at IIASA on June 24, 2019; the workshop invited all IIASA scientists to contribute. The workshop program can be found in Appendix A to this paper

Capturing protest in urban environments:The ‘police kettle’ as a territorial strategy

‘Kettling’ has emerged in recent decades as an established, if controversial, tactic of public order policing. Departing from a historical emphasis on dispersal, kettling instead acts to contain protesters within a police cordon for sustained periods of time. This article elaborates upon the spatial and temporal logics of kettling by investigating the conditions of is historical emergence. We argue that kettling should be understood as a territorial strategy that co-evolved in relation to forms of disruptive protest. Whereas techniques of crowd dispersal serve to diffuse a unified collective, ‘kettling’ aims to capture the volatile intensities of public dissent and exhaust its political energies. Drawing on police manuals, media coverage, accounts from activists and expert interviews, we show how the ‘kettle’ re-territorializes protest by acting on its spatio-temporal and affective constitution. By fabricating an inner outside of the urban milieu, freezing the time of collective mobilization and inducing debilitating affects such as fear and boredom, kettling intervenes into the scene of political subjectification that each congregation of protesting bodies seeks to fashion

Ascites induces modulation of α6β1 integrin and urokinase plasminogen activator receptor expression and associated functions in ovarian carcinoma

Interactions between cancer cells and the surrounding medium are not fully understood. In this study, we demonstrate that ascites induces selective changes in the expression of integrins and urokinase plasminogen activator/urokinase plasminogen activator receptor (uPA/uPAR) in ovarian cancer cells. We hypothesise that this change of integrin and uPA/uPAR expression triggers signalling pathways responsible for modulating phenotype-dependent functional changes in ovarian cancer cells. Human ovarian surface epithelial (HOSE) cell lines and epithelial ovarian cancer cell lines were treated with ascites for 48 h. Ascites induced upregulation of α6 integrin, without any change in the expression of αv, β1 and β4 integrin subunits. Out of the four ovarian cancer cell lines studied, ascites induced enhancement in the expression of uPA/uPAR in the more invasive OVCA 433 and HEY cell lines without any change in the noninvasive OVHS1 and moderately invasive PEO.36 cell lines. On the other hand, no change in the expression of α6 integrin or uPAR, in response to ascites, was observed in HOSE cells. In response to ascites, enhancement in proliferation and in adhesion was observed in all four ovarian cancer cell lines studied. In contrast, no significant increase in proliferation or adhesion by ascites was observed in HOSE cells. Ascites-induced expression of uPA/uPAR correlated with the increased invasiveness of HEY and OVCA 433 cell lines but was not seen in OVHS1, PEO.36 and HOSE cell lines. Upregulation of α6 integrin and uPA/uPAR correlated with the activation of Ras and downstream Erk pathways. Ascites-induced activation of Ras and downstream Erk can be inhibited by using inhibitory antibodies against α6 and β1 integrin and uPAR, consistent with the inhibition of proliferation, adhesion and invasive functions of ovarian cancer cell lines. Based on these findings, we conclude that ascites can induce selective upregulation of integrin and uPA/uPAR in ovarian cancer cells and these changes may modulate the functions of ovarian carcinomas

Angiopoietin-1 inhibits tumour growth and ascites formation in a murine model of peritoneal carcinomatosis

Angiopoietin-1 is an important regulator of endothelial cell survival. Angiopoietin-1 also reduces vascular permeability mediated by vascular endothelial growth factor. The effects of angiopoietin-1 on tumour growth and angiogenesis are controversial. We hypothesised that angiopoietin-1 would decrease tumour growth and ascites formation in peritoneal carcinomatosis. Human colon cancer cells (KM12L4) were transfected with vector (pcDNA) alone (control) or vector containing angiopoietin-1 and injected into the peritoneal cavities of mice. After 30 days, the following parameters were measured: number of peritoneal nodules, ascites volume, and diameter of the largest tumour. Effects of angiopoietin-1 on vascular permeability were investigated using an intradermal Miles assay with conditioned media from transfected cells. Seven of the nine mice in the pcDNA group developed ascites (1.3±0.5 ml (mean±s.e.m.)), whereas no ascites was detectable in the angiopoietin-1 group (0 out of 10) (P<0.01). Number of peritoneal metastases (P<0.05), tumour volume, (P<0.05), vessel counts (P<0.01), and tumour cell proliferation (P<0.01) were significantly reduced in angiopoietin-1-expressing tumours. Conditioned medium from angiopoietin-1-transfected cells decreased vascular permeability more than did conditioned medium from control cells (P<0.05). Our results suggest that angiopoietin-1 is an important mediator of angiogenesis and vascular permeability and thus could theoretically serve as an anti-neoplastic agent for patients with carcinomatosis from colorectal cancer